WesElyMD Profile picture
Mar 16 8 tweets 5 min read
1/🧵🎥 “It’s a very bad disease. It can be overcome.”
 
My #COVID patient tearfully speaks of his BIG DECISION on the ventilator.

This soldier & leukemia survivor made it through 3 weeks on a ventilator. How?
 
Video shown w his permission “to help others find hope, Doc.”
#Hope
2/ This immunocompromised man was in massive viral septic shock from COVID.

Huge doses of vasopressors.

Gargantuan levels of O2 & vent pressure to save his life.

Lungs, Kidneys, Heart and Brain all failed.
3/ His wife was there with him daily.

We put up pictures of his kids and pets.

We talked to him about the things he loved every day (even when sedated and seemingly unable to hear us).

Somewhere in all of that, he made a silent decision…
4/ “Sir, while I was down and under, I made a decision.

“Over time, you have to decide to live. If you decide to #live then everything else falls into place.

“So in my mind, you decide to live & then everything will fall into place. And then eventually you work through it.”
5/ I asked, “Sir, you were on that ventilator so long. What was it like being delirious?”
 
Him: “You’re on the in & out. I asked one of my sons, what are you gonna do today? He wouldn't answer me. So I asked the next one. He wouldn't talk to me either. They weren’t there.”
6/ But my wife, she called up both of them and said "Dad needs to talk to you. You tell him what's going on for today." And that's everything right there.
 
He was hallucinating with ICU #Delirium, which is so common in COVID:
 
bit.ly/3vQ7SaF
7/ I don’t want anyone to lose hope due to #PICS & #LongCOVID.
 
I tell him: “You can get your brain back. Brain cells have gone on vacation & we're gonna get them back through types cognitive rehabilitation - Sudoku, and Scrabble
 
All in due time.

wb.md/3JvUH6d
8/fin
What does this brave soldier think of COVID?
 
“Overall, sir, it's a very bad disease. Very bad. But also I think the disease can be overcome. And like you just said, it's gonna take a while...
 
Friends, please stay safe & work to keep others safe.

And get fully #VAXXED.

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More from @WesElyMD

Mar 11
1/🧵 Let’s learn about Ace inh-induced angioedema
 
His lips & tongue swelled up hours after taking a blood pressure med he’d been on 10 years - lisinopril.

📍What’s the treatment?
📍Is it an allergy?
📍What’s a common thought error?

(Pic w Perm - trigger warning tweets 2 & 4)
2/ Angioedema is potentially life-threatening
 
It’s very scary to see the tongue & lips swelling up so much and the airway compromised.

The patients are watched in the ICU so that intubation and even tracheostomy can occur emergently if required.

What’s the Dz Mechanism?
3/ Is ACE-inh induced Angioedema an allergy?
 
NO! It’s not an IGE mediated allergic reaction.

💥 Pro Tip:
People can get angioedema from allergies, but they would be very itchy, and my patient was not itching at all.

That's because it's mediated by a buildup of bradykinin.
Read 11 tweets
Mar 10
1/🧵 Let’s talk Long COVID:

I’m grouping several important & interesting articles about the reality of #LongCOVID.

By studying brain fluid, viral persistence & MRIs, we’re building our understanding of the “how” & “why” of this devastating malady.

A train is coming, read on…
2/ Cerebrospinal Fluid Offers Clues to #BrainFog

Most pts w new “thinking problems” after mild #COVID had abnormalities in fluid from lumbar punctures (image); controls did not.

Delayed #LongCOVID was common in younger people who thought they were safe.

bit.ly/3pS0JWN
3/ Believing those with #LongCOVID complaints is our 1st basic show of support!

“If people tell us they have new thinking & memory issues, I think we should believe them rather than require that they meet certain severity criteria.”
Dr. Apple UCSF

bit.ly/3sUNczF
Read 16 tweets
Mar 9
1/🧵 A sister & two brothers were born into a wonderful family. They led an exciting life. 4 months ago, 2 of them died young of #COVID, unprotected. The surviving sibling decided to get Vaxxed but stopped after 1 shot & is now on ventilator (CT scan) w COVID pneumonia. Read on…
2/ A teaching Point: This CT scan shows “holes” in his lung (red lines above & arrows👇) surrounded by white pneumonia.

The holes are previously damaged lung from smoking.

Millions in society, victims of misinformation, remain unprotected & the vaccine could save their lives.
3/ Let’s all do our part to teach others.

When polio hit, almost everyone wanted to be vaccinated despite the disclosed risk of getting polio from the live attenuated vaccine.

This vaccine is even safer and yet the untruths spewed by many have tainted our uptake.
Read 4 tweets
Mar 3
1/🧵 WAKE UP - #COVID is a Ball & Chain for heart disease & stroke.
 
This 154,000 pt study & others solidify COVID as a PREDICTOR of a variety of CardioVascular Dzs.
 
Translation: #LongCOVID pts suffer heart attacks, strokes & much more.
 
#Vaccinate!
 
go.nature.com/3pxKjmi
2/ SHOCKER: Amazing work scientifically. Every med student is taught to gauge Cardiovascular risk history: Smoking, Obesity, HTN, Cholesterol, Family History…

Add COVID to the list. Solid data from @NatureMedicine of US Veterans used >11M contemporary + historical controls!
3/ Main figure shows both hazard ratios & excess burden per 1,000 persons of highlighted types of problems like strokes, V Tach & #POTS, myocarditis, heart attacks, heart failure & blood clots in 154,000 people 30 days after COVID vs. 5,637,647 contemporary controls.
Read 13 tweets
Feb 28
1/🧵 Are you happy?

My brother w #DownSyndrome is teaching me tons of life lessons.

In medicine & in life, I make big decisions based on guesstimates of other’s Quality of Life #QOL.

I often GET IT WRONG!
 
What do adults w #disability teach me about TRUTH?

Can I learn? Image
2/🎥 How do we “calculate” someone’s #QOL?
 
#Confession: I get it all wrong when I impose MY judgment onto THEIR life.
 
Greg, my 57 y/o brother-in-law with Down Syndrome, has a better QOL than I do.

Why?

Digest this…read on…
 
#DownSyndromeLove
3/ My working definition of QOL is “the ability to give & receive love.”

REREAD THAT👆

Greg understands the Law of the Gift: Treasures GROW when we give them away.

It’s the opposite of hoarding.

Yet, giving ourselves to others can be SCARY. Greg ponders deeply these emotions. Image
Read 16 tweets
Feb 21
1/🧵 Paul Farmer has died.

It is so heartbreaking 💔. Let us collectively mourn his passing - one of the greatest #PublicHealth figures in the history of Medicine.

His @PIH is a tribute to a kinder gentler way to love each other.

More…
2/ Dr. Farmer started his vocation of #SocialJustice by serving the beautiful people of Haiti, the world’s 1st Black republic. He looked in their eyes & saw their needs…HIV, malaria, Tb, hunger, poverty, neglect.

In response he took action…

(paintings below by my daughter)
3/ Paul Farmer is the central figure in Kidder’s 📚 “Mountains Beyond Mountains.” If you haven’t read it, order now.

Through his drive and insights we learned to say “Yes” to bringing modern medicine to the most remote settings of human life on Earth 🌍
Read 6 tweets

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